Your Questions
Your Questions
Q: Dr. Eppley, I am interested in custom jaw implants. I had a chin wing osteotomy done three months ago and I am happy so far with the result, but not with the width of my jaw and the asymmetry. Is it possible to get this procedure done after a chin wing osteotomy? When could I get the surgery this year? How much will it cost? How long do I have to stay?
A: It is possible to do a custom jaw implant after a chin wing osteotomy. I have done numerous such cases. The chin wing osteotomy provides no facial width, no posterior jaw angle vertical lengthening and often ends up asymmetric/irregular. I would wait until six months after the chin wing procedure to be certain you known exactly the dimensional jaw changes you want to achieve. A custom jaw implant will require a 3D CT scan for implant design. You have a very good knowledge of the recovery based on your chin wing osteotomy experience. It would be similar to that although the amount of swelling may or may not be less.
The cost of a custom jaw implant will be greater than that of the chin wing due to the design and fabrication of the implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in custom jaw implants. I had a chin wing done 3 months ago and I am happy so far with the result, but not with the width of my jaw and the asymmetric. Is it possible to get this procedure done after a chin wing osteotomy? When could I get the surgery this year? How long do I have to stay after surgery?
A: It is possible to do a custom jaw implant after a chin wing osteotomy. I have done numerous such cases. The chin wing osteotomy provides no facial width, no posterior jaw angle vertical lengthening and often ends up asymmetric/irregular. I would wait until six months after the chin wing procedure to be certain you known exactly the dimensional jaw changes you want to achieve. A custom jaw implant will require a 3D CT scan for implant design. You have a very good knowledge of the recovery based on your chin wing experience. It would be similar to that although the amount of swelling may or may not be less.
I will have my assistant Camille pass along the cost of a custom jawline implant to you tomorrow.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jaw implant. I have always felt my mandible is very under developed and I am starting to think my neck and jowls are slowly swallowing the thing. I just turned 35 and I look like I’m about 21 years old. I feel this is mostly because my mandible hasn’t grown much since I was a teenager. As a male, I feel like I project slight weakness because of my insecurity. I thought for a long time I would outgrow my dissatisfaction but unfortunately that has not been the case. I have also been hopeful that my face would eventually full out, but that too has not occurred.
I read countless reports about chin implants and jawbone expansion techniques, etc. your website had the most comprehensive descriptions of what I feel is “wrong” with my ever slimming face. I like your description of how the jawline can be lowered as well as widened with specific implants. I want to keep my “shape”, but I want it to be lowered and widened. Does that make sense?
A: Thank you for sending your pictures. What I see is an entire lower jaw that is both vertically and horizontally short. This makes it disproportionate to the upper two-thirds of your facial structures. This is the ideal anatomic deficiency for which a custom jaw implant works so well to correct and put the face in balance.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom jawline implant. One year ago I had jaw surgery and a sliding genioplasty. I had a receding chin and an overbite so it was recommended o have my jaw brought forward and have a sliding geniplasty instead of a chin implant. The surgery was certainly not fun and I was very swollen for many months. Six months after the surgery I was happy with how my face looked but as the swelling further reduced my face became more narrow and asymmetrical. I ended up with a very narrow asymmetric face and a very pointy chin. This was devastating for me as this was not how I envisioned I would look. I thought I would get a stronger more chiseled jaw and mandible as this is what the surgeon told me! But I ended up with a very long and narrow looking face.
I consulted another surgeon to ask about getting implant/implants to fix the asymmetry but he didn’t recommend it. He recommend fillers or a fat transfer. I ended up getting fillers but the asymmetry was so much (and the volume loss on the right side) that I had to have six treatments. It was expensive and I still wasn’t happy with it. I’m looking for a permanent solution.
A: Thank you for your inquiry and detailing out your surgical history and current concerns . While moving the chin and mandible forward does enhance anterior skeletal projection, it almost always does so at the expense of width. (A U-shaped structure that comes forward in two places will be more narrow….this is magnified when the surgical trauma and swelling causes soft tissue atrophy) While an effort at injectable treatment was worthy of the effort, to prove to yourself what the results would be, it never was a long-term solution. In addition, no form of fillers or fat can create skeletal highlights or angularity, all they can do it makes things puffy and round which is why they rarely are effective for jawline augmentation.
It would seem by your concerns and pictures that custom jaw implant would create the missing chin and jaw line dimensions. This is done using a current 3D CT scan. This is also an excellent method for improving any bony asymmetries since the computer design process can make those adjustments done to the 1mm level.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley,I know I am interested in at least a custom jaw implant. I have noticeable facial asymmetry. What procedures will fix the following concerns? Long face; weak chin, asymmetric jaw;flat face; asymmetric eyelids;and no browbone projection.
A: Thank you for your inquiry and sending your pictures. In looking at them your biggest facial deficiency is in the lower third of your face. Your entire lower jaw is short, leading to a weaker chin and lack of any jaw angle prominence. Your face would probably not look as long if the lower third of the face was more prominent. There is also some asymmetry of the lower jaw which is magnified because of its underdevelopment. To best treat this type of lower jaw deficiency, a custom jaw implant made from a 3D CT scan would treat both the lower jaw deficiency and asymmetry at the same time.
The flatter face is partly due to the lower jaw but the lack of cheek prominent contributes to it as well. There is where cheek implants would make a contribution.
I don’t see the type of eyelid asymmetry that is easily improvable by eyelid surgery.
Lack of brow bone projection is best treated by a brow bone implant placed through an endoscopic approach.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a custom facial implants. I currently have a jaw/chin implant in place which I want removed and replaced with a wrap around, custom made jaw implant (and possibly a cheek implant replaced). Is this possible to do as one surgery, I was diagnosed with a mild case of hemifacial microsomia, so my cosmetic procedures were focused on only one side. I had a single jaw angle implant placed on the left side, and 1/2 of a chin implant with an extending wing place on the left side as well. I also has cheek implants placed on both sides, and one appears to be much more prominent than the other post-op. All of these implants were done during one surgery, and I believe they are all silicone implants. I would like to create more symmetry and balance in my entire lower face, and provide more jawline definition while maintaining a feminine look (no squareness in the jaw, as the left is now).
A: With your history of congenital facial asymmetry and an attempt using standard stock implants, the only way to really make significant improvement is to have custom facial implants made. With the computer, all bony asymmetries can be precisely corrected and precision fit of the implants can be obtained. You probably have a very good result from the prior surgery but it just shows the limitations of using standard-sized implants for a face that is not normally formed. (asymmetric)
Dr. Barry Eppley
Indianapolis, Indiana